1. Field of the Invention
The present invention relates generally to medical apparatus and methods. More particularly, the present invention relates to methods and apparatus for providing transapical access to a heart chamber to facilitate performing various procedures within the heart chamber, such as heart valve replacement, valve repair, atrial septum repair, aneurysmectomy, and the like.
Heart valve replacement and repair on beating hearts are typically performed via a transvascular or a transapical approach. Of particular interest to the present invention, transapical access is typically established via an intercostal incision and placement of a relatively large cannula to provide access to the apex of the heart. Conventional surgical tools are then used through the cannula to form an incision into the heart to allow passage of the interventional tools used for the heart valve replacement, repair, or other procedure. Frequently, a purse string suture is pre-placed at the site of the incision to facilitate closure after the procedure is complete.
The need to use conventional surgical tools for making the incision through the apical region into the heart chamber requires that a relatively large access port be placed through the intercostal space, typically between the fourth and fifth ribs. The incision is typically 4 or 5 cm in length, and such incisions in the abdomen are very painful to the patient.
For these reasons, it would be desirable to provide improved apparatus and methods for both accessing a heart for transapical penetration and for closing the penetration after the related procedure has been completed. Such apparatus and methods would preferably require a smaller intercostal incision than has often been necessary in the past, and in particular, it would be desirable if the incision were below 5 cm, preferably below 4 cm, and still more preferably below 3 cm, or less. Methods and apparatus should further provide for both simplified access and closure protocols, should present minimum risk to the patient, be economical, and be relatively uncomplicated for use by the physician. At least some of these objectives will be met by the inventions described below.
2. Description of the Background Art
U.S. Patent Publ. Nos. 2011/0015728; 2011/0004235; and 2009/0287183 describe devices for transapically accessing a heart chamber for performing valve replacement and other procedures. U.S. Patent Publ. No 2010/0268253 describes a self-closing structure that can be disposed about a transapical access site. U.S. Pat. No. 4,204,541, describes a helical needle for performing vertical suturing in tissues including cardiac and live tissue. U.S. Pat. Nos. 7,758,595; 7,637,918; 5,545,148; and 5,356,424; and U.S. Patent Publ. Nos. 2009/275960; 2008/275473; 2006/253127; and 2006/212048 describe other suturing devices with helical needles.